| NPI | 1295941409 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JOHN L BOSTANCHE Physician/Owner 262-652-3668 |
| Organization Subpart ? | No |
| Primary Taxonomy | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: WI 025) |
| Additional Taxonomies | 213ES0103X Podiatrist, Foot & Ankle Surgery (Licence: IL 016) |
| Enumeration Date | 2007-05-15 |
| Last Update Date | 2021-09-20 |